1. Permanent Supportive Housing: Impact on Hospital and Jail Usage for High Utilizers Virginia Supportive Housing Kristin Yavorsky Supportive Services Director

2. The Permanent Supportive Housing Model Permanent supportive housing (PSH) is a program model that combines affordable rental housing with community-based supportive services. PSH has been identified by the federal Substance Abuse and Mental Health Services Administration as an evidenced-based practice for individuals experiencing chronic homelessness who also have serious behavioral or physical health conditions. Multiple peer-reviewed research studies, including seven randomized controlled trials, have found that PSH is particularly effective in improving participants housing stability and reducing their emergency department and inpatient hospital utilization. The target population is often among the highest utilizers of these and other costly public services while homeless.

3. About Virginia Supportive Housing Virginia Supportive Housing (VSH) is a non-profit organization founded in 1988 expressly to provide permanent supportive housing to homeless individuals. For the last seven years, VSH has been deeply targeting individuals with the longest histories of street homelessness who often have co-morbid physical and behavioral health conditions. A Housing First approach is used. Supportive services at VSH include community-based case management with a low staff to client ratio, peer recovery services, street outreach, landlord mediation, healthcare navigation, medication management, independent living skills training, and assistance with benefits acquisition. As direct result of a community effort to target and prioritize unsheltered homeless individuals for permanent supportive housing – Richmond has saw a 40% reduction in its annual count of unsheltered homeless individuals from July 2011 – July 2013.

4. VSH Apartments Community-Based Apartments Total - PSH for Individuals RegionClients Richmond138160298 Hampton Roads24091331 Charlottesville600 TOTAL438251689

5. Chronically Homeless88 % Veterans18 % Mental Health Condition76 % Substance Abuse Condition53 % Chronic Physical Condition or Disability68 % Client Characteristics (n = 287 clients served by VSH in Richmond in 2013)

6. VSH Housing Outcomes – 2013 Richmond 81 individuals newly housed in PSH 97% (n=287) did not return to homelessness

7. Hospital Utilization and Cost Outcomes Pre and Post Permanent Supportive Housing VCUHS shared data for mutual clients served across all three VSH permanent supportive housing programs through the end of calendar year 2013. Of the initial data set of 253 VSH clients, 95.3% were found to have utilized VCUHS inpatient or Emergency Department (ED) services in the indicated time frame. VSH conducted an analysis of this data to determine – (1) inpatient and ED utilization – (2) return hospital visits within 30 days, and – (3) fiscal impact

8. Hospital Utilization and Cost Outcomes 148 individuals were identified who had been in housing for at least twelve months. 495 inpatient or ED visits during the 12 months prior to housing and only 228 visits in the 12 months after housing – a 54% reduction in the number of visits. Actual payments per ED visit increased by 76% after VSH housing, and payments per inpatient visit increased by 126%.

9. The 20% Highest Utilizers A small subset of 30 patients accounted for 63.4% (314) of the full group’s inpatient and ED visits while homeless. One patient of note had 61 ED visits in the year before being housed and none afterward.

10. Number of ED & Inpatient Visits to VCUHS – 12 months before and after VSH Housed (n=30) EDInpatient Homeless26846 VSH Housed6822 - 71%

11. Annual Average VCUHS Visits Per VSH Client EDInpatient Both Homeless8.92.3 10.5 VSH Housed1.50.73.0

12. Return visits to VCUHS ED or Inpatient within 30 Days of Discharge (excluding same day returns) Number of Visits Homeless187 VSH Housed35

13. Average Days between VCUHS Visits EDInpatient Homeless33.940.3 VSH Housed70.684.2

14. Total Monthly VCUHS ED + INPT Visits Before and After Move In for High Utilizers Month

15. Fiscal Impact to VCUHS for Housing High Utilizers $560,068 reduction in unpaid charges Savings of $18,669 per patient.

16. Richmond City Jail Utilization Preliminary Analysis 98 VSH clients had data available a stay in housing of at least a year and a record in the City jail (ever). 36.7% (36) had an incarceration in the time frame. Post VSH housing results for those with an incarceration: 28.6% decrease in number of incarcerations 37.8% decrease in jail days 54.9% decrease in number of clients incarcerated (for at least one day) 37.8% reduction in total jail cost Total cost savings $39,900 or $1,108 per person.

17. Contact information: Kristin Yavorsky Supportive Services Director kyavorsky@virginiasupportivehousing.org